Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 26, 2022; 10(9): 2895-2900
Published online Mar 26, 2022. doi: 10.12998/wjcc.v10.i9.2895
Parasitic leiomyoma in the trocar site after laparoscopic myomectomy: A case report
Chul Kyu Roh, Hyuk-Jae Kwon, Min Jung Jung
Chul Kyu Roh, Department of Surgery, National Police Hospital, Seoul 05715, South Korea
Hyuk-Jae Kwon, Department of Surgery, Ajou University School of Medicine, Suwon 16499, South Korea
Min Jung Jung, Department of Pathology, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
Author contributions: Kwon HJ and Roh CK drafted the paper; Roh CK and Jung MJ revised the manuscript; Kwon HJ and Roh CK collected patient’s information; Roh CK performed the treatment for this patient.
Informed consent statement: This case report was approved by our institutional review board (Approval No. AJIRB-MED-EXP-21-424), who waived the requirement for informed consent because of full anonymization of patient information. However, written informed consent was obtained from the patient.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Min Jung Jung, MD, Assistant Professor, Department of Pathology, College of Medicine, The Catholic University of Korea, 327, Sosa-ro, Wonmi-gu, Seoul 06591, South Korea. sobac80@hotmail.com
Received: November 11, 2021
Peer-review started: November 11, 2021
First decision: January 11, 2022
Revised: January 13, 2022
Accepted: February 15, 2022
Article in press: February 15, 2022
Published online: March 26, 2022
Processing time: 131 Days and 7.5 Hours
Abstract
BACKGROUND

Laparoscopic myomectomy is increasingly used for resecting gynecological tumors. Leiomyomas require morcellation for retrieval from the peritoneal cavity. However, morcellated fragments may implant on the peritoneal cavity during retrieval. These fragments may receive a new blood supply from an adjacent structure and develop into parasitic leiomyomas. Parasitic leiomyomas can occur spontaneously or iatrogenically; however, trocar-site implantation is an iatrogenic complication of laparoscopic uterine surgery. We describe a parasitic leiomyoma in the trocar-site after laparoscopic myomectomy with power morcellation.

CASE SUMMARY

A 50-year-old woman presented with a palpable abdominal mass without significant medical history. The patient had no related symptoms, such as abdominal pain. Computed tomography findings revealed a well-defined contrast-enhancing mass measuring 2.2 cm, and located on the trocar site of the left abdominal wall. She had undergone laparoscopic removal of uterine fibroids with power morcellation six years ago. The differential diagnosis included endometriosis and neurogenic tumors, such as neurofibroma. The radiologic diagnosis was a desmoid tumor, and surgical excision of the mass on the abdominal wall was successfully performed. The patient recovered from the surgery without complications. Histopathological examination revealed that the specimen resected from the trocar site was a uterine leiomyoma.

CONCLUSION

Clinicians should consider the risks and benefits of laparoscopic vs laparotomic myomectomy for gynecological tumors. Considerable caution must be exercised for morcellation to avoid excessive tissue fragmentation.

Keywords: Laparoscopic myomectomy; Parasitic leiomyoma; Trocar site; Implantation; Morcellation; Case report

Core Tip: A 50-year-old female presented with a palpable mass on the left quadrant of the abdomen after laparoscopic myomectomy using power morcellation. We treated the mass by surgical excision. No other complications were observed during follow-up. According to our findings, parasitic leiomyoma may be developed in the previous trocar-site following laparoscopic morcellation. Parasitic leiomyoma is a late complication of laparoscopic myomectomy. Caution should be exercised when performing laparoscopic myomectomy or hysterectomy using power morcellation.